Thursday, May 8, 2008

More APA Notes: Conversations with the "Enemy"

About 20,000 psychiatrists attend the APA annual meeting, and as you wander around the convention center, you bump into people you wouldn't ordinarily be rubbing shoulders with. Even people you might go out of your way not to rub shoulders with. This is a good thing, because you find out quickly that your "enemy" is no monster, but a person just like you. And possibly not an enemy at all.

Two examples from the 2008 meeting stand out; I'll describe one today and one tomorrow.

As I was browsing the publisher's exhibit area, I saw Stephen Stahl at the Cambridge University Press booth, signing copies of the latest edition of his immensely popular textbook, Essential Psychopharmacology. Apart from being a prolific author, Stahl is the head of NEI (Neuroscience Education Institute), a medical education company specializing in industry-funded CME. I mentioned him in this prior post, when I put him in the company of Charles Nemeroff as one of the more industry-conflicted psychiatrists in the profession.

Well, I went up to him and introduced myself, and we got talking about industry influence in psychiatry. "We're moving away from pharma funding," he said. For example, he said that he plans to stop participating in industry-supported symposia. "I consult with industry," he said, "and so I shouldn't be doing these symposia." I told him that I was on an APA work group tasked with adapting to future loss of industry funding. I asked him how he thought the organization would manage. "We're not going to make as much money," he said, "and maybe we shouldn't. Sometimes we just have to do the right thing."

I was impressed. But it was ironic that our short conversation was just then interrupted by a Pfizer employee asking him to sign her copy of his book. "We'll be seeing you tonight, Dr. Stahl," she said graciously. I don't know what event she was referring to, but I do know that the Pfizer was giving away his book at their display in the exhibit hall, and had scheduled him to sign copies for the dozens of psychiatrists happy to stand in line for a freeby.

Nonetheless, I believed Dr. Stahl was sincere in his plans to reduce his spigot of industry money, and I hope that we'll start seeing changes in NEI's business model over the coming year.

Tomorrow: Close encounters with John Shelton, publisher of Journal of Clinical Psychiatry.

I used to admire Steven Stahl; his book provided a way to learn psychopharmacology in a light, "fun" way; I went to one of his interactive conferences 11 years ago(paid for, incidentally, by a pharma company--the tuition, not transportation and hotel--this was back in the days when I still hadn't realized the extent to which pharma was "buying" the profession)--his teaching methods there were also "fun"and appealing---then a phase followed where when he recommended various medications for various problems I thought it must be "OK because it's Stahl"---I've come to believe that now he'd recommend a medication for anything and everything

Of course he's nice; all of the front people for Pharma are nice. If they weren't, it wouldn't be good for sales. So he thinks we need to move away from Pharma huh?

His comments made me think about a recent visit to Des Moines by the head honcho of Pharma (the congressman who pushed through Medicare D in the middle of the night). He came to speak to physicians there about steps we can take to reduce medication use. Good one...Hee-hee!